The role of deviant sexual fantasy in the etiopathogenesis of sexual homicide: A systematic review

Much research examining the etiopathogenesis of sexual homicide has focused on the role of deviant sexual fantasy. However, there are fundamental questions as to the nature of the relationship between deviant fantasy and sexual homicide that remain unanswered. Given that most people are likely to entertain deviant fantasies without really desiring to put them into practice, it is important to understand how and why some people develop deviant sexual fantasies and act on them. To understand the mechanisms that promote development and acting out of deviant fantasy in sexual murders, this paper addresses the available scientific evidence on the topic, by providing a systematic review of the studies that have investigated the role of fantasy in the etiopathogenesis of sexual homicide. Five databases were searched, supplemented with hand-search of reference lists from retrieved papers. The author and a psychiatrist independently evaluated eligibility of all studies identified, abstracted data, and assessed study quality. Disagreements were resolved by consensus. Seven studies, including 171 subjects, were analyzed. Results suggest that deviant sexual fantasies can promote sexual homicide when combined with early traumatic experiences and social and/or sexual dysfunction. Implications for research, treatment, health policy, and criminal investigation are discussed.